The invention relates to a medical gripping instrument, especially for use in microlaryngoscopy, comprising a longitudinal shaft on whose distal end a pincer part is arranged, which can be moved between a closed and an opened position. A handle consisting of a fixed handle part and of a handle part that can pivot in relation to the fixed handle part is arranged on the proximal end of said shaft. The pincer part is moved via a push/pull rod, which is mounted in the shaft and which is connected to a pivotal handle part. The gripping instrument also comprises a spreading part, which can be tilted from the shaft. In addition, the invention relates to a process for using this medical gripping instrument in microsurgical and especially in laser-surgical microlaryngoscopy.
It is common in microsurgical and especially in laser-surgical microlaryngoscopy, in which tissues are to be removed, to insert a gripping instrument into the patient""s body through the shaft of a fixed endoscope. On the one hand, this procedure facilitates the severing of a tissue part by means of another medical instrument, such as a laser, and, on the other hand, serves to remove the severed tissue from the patient""s body. The particular risk in laser-surgery is that the tissue to be spared will also be damaged during such a surgery, especially due to the heat caused by the use of laser.
For example, a medical gripping instrument of the aforementioned type has been disclosed in U.S. Pat. No. 5,456,695 A. The gripping instrument disclosed therein comprises a handle consisting of two handle parts. A pincer part on the distal end of the shaft can be moved between a closed and an opened position by means of said handle. In addition to said pincer part on the distal end of the shaft, a fan-shaped spreading part is arranged on the center part of said shaft, over which the individual fan blades used as retractors within the pincer part""s range of adjustment can be pivoted from the shaft so as to press the tissue to the side, for example. The spreading part can be pivoted from its resting position in the shaft into the tilted spread position by turning the ring. The said ring is arranged on the distal end of the handle, that is, within the shaft""s range of extension.
Apart from the fact that it is necessary to always use both hands for operating with the aforementioned gripping instrument if both the pincer part and the spreading part must be used at the same time, since it is not possible to use the handle parts and simultaneously turn the ring with a single hand only, the drawback of the aforementioned gripping instrument is that there is a distance between the spreading part and the pincer part when said spreading part has been shifted towards the proximal end of the shaft, and that said spreading part is used within the pincer part""s range of adjustment. Especially in a restricted space, as in laryngoscopy for example, this design of the spreading part makes it difficult to protect the non-operable tissue so that only grip the tissue held by the pincer part is exposed to surgical intervention.
In accordance with the current state of technology, it is the objective of the present invention to provide a gripping instrument of the type mentioned at the beginning, which is simple in its structure, easy to be used, which ensures that the tissue to be removed will be protected. Moreover, it is the objective of the present invention to provide a procedure for the use of said medical gripping instrument.
The solution to this objective is characterized in that the spreading part, which can be tilted from the shaft, isxe2x80x94in addition to the pincer partxe2x80x94arranged on the distal end of the shaft, and that said spreading part can be tilted from the shaft within a certain range into an approximate right-angled position to the range of adjustment.
In the present invention, through the arrangement of the spreading part on the distal end of the shaft, i.e. in immediate proximity to the pincer part, the tissue to be preserved, which is immediately adjacent to the tissue to be removed and gripped by the pincer part, can be pushed aside, even in restricted areas of operation, so that the said tissue to be preserved will not be affected. Furthermore, the spreading part""s approximately right-tangled tilting to the range of adjustment of the pincer part allows a largely independent movement both of the spreading part and of the pincer part.
The manipulation of the gripping instrument according to the present invention, and especially the surgery carried out with a single hand, is made possible because the spreading part can be tilted by means of an additional handle part of the handle.
The use of the said gripping instrument equipped with the additional spreading part makes it possible to keep the tissue to be preserved separate from the area of surgery, in order to provide more space and a better overview for surgery. Moreover, the advantage of the gripping instrument according to the present invention is that it can be used directly by manipulating the said gripping instrument, and thus that this additional accessory will be available to the surgeon at any time.
The gripping instrument in accordance with the present invention allows a facility in its use in that the pivotal handle part can be fixed in its respective position to the fixed handle part for adjusting the pincer part. By locking the pincer part in the gripping position, the surgeon now has the possibility of using the spreading part without having to move the pincer part at all.
According to a preferred embodiment of the present invention, a locking arm arranged on one of the two handle parts is used for fixing the pincer part, whereas the said locking arm is interacting with a locking element attached on the other handle part. As an advantageous feature, the said locking arm is provided with a saw-toothed profile on its surface.
According to a practical and preferred embodiment of the present invention, it is suggested that the locking arm is pivotal on one of the handle parts and, moreover, that it is spring-loaded in direction towards the stop location.
The invention""s gripping instrument can be especially well manipulated if the pincer part and the spreading part can be moved into an opened position, that is, tilted from the shaft, by as much as 90xc2x0; preferably 50xc2x0.
The procedure in accordance with the present invention for using said gripping instrument in microsurgical, and especially in laser-surgical microlaryngoscopy, is characterized in the following steps:
a) inserting the medical gripping instrument through a shaft of a fixed endoscope;
b) opening the pincer part over both accompanying handle parts of the handle, and gripping the tissue to be removed;
c) tilting the spreading part over the additional handle part of the handle;
d) keeping the tissue parts separate from the area of surgery by means of the spreading part, in order to provide more space and a better view, especially in laser surgery;
e) severing the tissue gripped by the pincer part by means of a surgical instrument, especially by means of laser; and
f) moving back the spreading part onto the shaft after the surgery, and withdrawing the medical gripping instrument together with the tissue to be removed.
Thus, the procedure according to the present invention enables the surgeon, by means of the spreading part, to selectively separate from the area of surgery the tissue to be preserved.
Finally, the procedure according to the present invention can be simplified if the handle parts of the pincer part can be fixed in gripping position prior to tilting the spreading part.